POS0031 DO COMORBIDITIES INCREASE THE RISK OF FAILURE TO REACH REMISSION IN EARLY RHEUMATOID ARTHRITIS PATIENTS RECEIVING METHOTREXATE AS FIRST-LINE THERAPY?
Authors: L. Tidblad, H. Westerlind, B. Delcoigne, J. Askling, S. Saevarsdottir
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Previous studies have reported that some comorbidities associate with a lower probability of remission in patients with established rheumatoid arthritis (RA).[1, 2] Evidence on whether comorbidities affect remission in DMARD-naïve patients with early RA is, however, lacking. We have recently shown that most patients with early RA, irrespective of comorbidities, receive methotrexate (MTX) in DMARD monotherapy as first-line therapy.[3] <h3>Objectives</h3> The aim of this study is to examine whether specific comorbidities or overall comorbidity burden affect the likelihood of remission on MTX in DMARD monotherapy as first treatment in patients with early RA. <h3>Methods</h3> We included patients with a new RA diagnosis in the Swedish Rheumatology Quality register (SRQ) during 2007 to 2020, in total 11,001 incident RA cases, of whom 67% were female and 69% seropositive. Of these, 8,273 had a follow-up visit at 3 months. Information on comorbidities five years before RA diagnosis was retrieved from the Swedish National Patient Register and information on prescribed drugs 1.5 year before RA diagnosis from the Prescribed Drug Register. Comorbidity diagnoses were grouped into 10 categories (table 1). Disease activity measures were captured through SRQ. The primary outcome measure was failure to reach DAS28 remission, with Boolean, SDAI, CDAI remission, EULAR response and no swollen joints as secondary outcomes. Modified Poisson regression was used to calculate the relative risks of failure to reach remission, in relation to the comorbidities, adjusted for sex and age. <h3>Results</h3> In total, 53% of the RA patients had failed to reach DAS28 remission after 3 months of MTX monotherapy, ranging from 68% among the patients with psychiatric diagnoses to 48% of the patients with a history of cancer (figure 1). The relative risk of not reaching DAS28 remission after 3 months (table 1) was increased for patients with endocrine (RR:1.08, 95% CI 1.01 to 1.15) or gastrointestinal (RR 1.16, 95% CI 1.03 to 1.30) diseases, previous hospitalisation due to infectious diseases (RR= 1.21, 95% CI 1.06 to 1.38), psychiatric comorbidity (RR: 1.24, 95% CI 1.15 to 1.35) and respiratory diseases (RR=1.16, 95% CI 1.01 to 1.32). The comorbidity burden also associated with lower remission rates, with a 27% higher risk of not reaching DAS28 remission for the patients with ≥3 comorbidity categories compared to patients without comorbidities. A similar pattern was observed for the secondary outcome measures. <h3>Conclusion</h3> Specific comorbidities and the overall comorbidity burden associate with failure to reach remission to MTX as DMARD monotherapy in early RA patients. Comorbidities may be an important factor when assessing treatment outcomes in early RA. <h3>References</h3> [1]Ranganath, V.K., et al., <i>Comorbidities are associated with poorer outcomes in community patients with rheumatoid arthritis.</i> Rheumatology (Oxford), 2013. <b>52</b>(10): p. 1809-17. [2]Radner, H., et al., <i>The impact of multimorbidity status on treatment response in rheumatoid arthritis patients initiating disease-modifying anti-rheumatic drugs.</i> Rheumatology (Oxford), 2015. <b>54</b>(11): p. 2076-84. [3]Tidblad, L., et al., <i>Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study.</i> RMD Open, 2022. <b>8</b>(2). <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Liselotte Tidblad: None declared, Helga Westerlind: None declared, Bénédicte Delcoigne Grant/research support from: Partly employed by the ARTIS Swedish national safety monitoring system which receives financial support from Abbvie, Astra-Zeneca, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB; Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB., Johan Askling Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lily, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi and UCB, these entities have entered into agreements with Karolinska Institutet with JA as principal investigator, mainly in the context of safety monitoring of biologics via ARTIS/Swedish Biologics Register., Saedis Saevarsdottir Employee of: Part-time employee of deCODE genetics Inc., unrelated to this work.